Original article
Circumferential Versus Longitudinal Systolic Function in Patients with Hypertension: A Nonlinear Relation

https://doi.org/10.1016/j.echo.2006.08.024Get rights and content

Background

Depressed circumferential midwall performance and impaired left ventricular (LV) longitudinal function are both early markers of LV systolic dysfunction in patients with hypertension. The relation between midwall and longitudinal indices in these patients has never been analyzed.

Methods

In 126 patients with hypertension, midwall fractional shortening (mFS), stress-corrected mFS, M-mode left atrioventricular plane displacement, and tissue Doppler–derived peak mitral annular systolic velocity were determined.

Results

Regression analysis showed that the relations of midwall indices to atrioventricular plane displacement and mitral annular systolic velocity were all nonlinear. Reductions in atrioventricular plane displacement or mitral annular systolic velocity within their higher ranges corresponded to relatively smaller decreases in mFS and stress-corrected mFS. Relative wall thickness was the strongest determinant of the relative efficiency of circumferential and longitudinal LV contraction.

Conclusion

The relation between circumferential midwall and longitudinal function in patients with hypertension is nonlinear and dependent on LV geometry. In these patients, systolic impairment occurs earlier in longitudinal than circumferential performance.

Section snippets

Study Population

In all, 126 consecutive patients, aged 16 years or older, affected by stage II to III arterial hypertension, and having visited our echocardiography laboratory for a general evaluation of cardiovascular risk, were retrospectively included in this study. Patients were excluded if they had any of the following: evidence of secondary hypertension by extensive clinical, laboratory, and instrumental examinations; 2+ or greater mitral regurgitation; aortic regurgitation; any degree of valvular

Curve Fitting Analysis

The main characteristics of the study population are shown in Table 1. Nonlinear regression analysis showed that the relations of mFS and ScmFS (Figure 1) to AVPD and Sm were all best fitted by an inverse exponential function, a mathematic equivalent of the S-function previously used by Emilsson et al29 to describe the relation of EF to AVPD. Compared with the linear models (mFS = 10.25 + 0.53. AVPD, R = 0.45, P < 0.0001; mFS = 12.71 + 0.50 Sm, R = 0.40, P < 0.0001; ScmFS = 50.08 + 3.24. AVPD, R

Discussion

This study is the first to explore the relation between circumferential midwall and longitudinal LV systolic function in patients with hypertension. Our results indicate that in these patients: (1) a nonlinear relation between circumferential and longitudinal LV systolic indices exists; (2) systolic impairment occurs earlier in longitudinal than circumferential performance, even when the latter is assessed at the midwall; and (3) the nonlinearity of this relation is dependent on the effect of

References (47)

  • M.J. Roman et al.

    Relation of arterial structure and function to left ventricular geometric patterns in hypertensive adults

    J Am Coll Cardiol

    (1996)
  • G. de Simone et al.

    Assessment of left ventricular function by midwall fractional shortening/end-systolic stress relation in human hypertension

    J Am Coll Cardiol

    (1994)
  • M.A. Quinones et al.

    Recommendations for quantification of Doppler echocardiography: a report from the Doppler quantification task force of the nomenclature and standards committee of the American Society of Echocardiography

    J Am Soc Echocardogr

    (2002)
  • K. Emilsson et al.

    The relation between mitral annulus motion and ejection fraction: a nonlinear function

    J Am Soc Echocardiogr

    (2000)
  • M.Y. Henein et al.

    Asynchronous left ventricular wall motion in unstable angina

    Int J Cardiol

    (1997)
  • E. Rydberg et al.

    Left atrioventricular plane displacement predicts cardiac mortality in patients with chronic atrial fibrillation

    Int J Cardiol

    (2003)
  • P.P. Sengupta et al.

    Effects of percutaneous mitral commissurotomy on longitudinal left ventricular dynamics in mitral stenosis: quantitative assessment by tissue velocity imaging

    J Am Soc Echocardiogr

    (2004)
  • R. Yilmaz et al.

    Assessment of left ventricular function by Doppler tissue imaging in patients with atrial fibrillation following acute myocardial infarction

    Int J Cardiol

    (2005)
  • M.Y. Henein et al.

    Assessment of cardiac risk before peripheral vascular surgery: a comparison of myocardial perfusion imaging and long axis echocardiography at rest

    Int J Cardiol

    (2001)
  • K. Serri et al.

    Global and regional myocardial function quantification by two-dimensional strain: application in hypertrophic cardiomyopathy

    J Am Coll Cardiol

    (2006)
  • R. Willenheimer et al.

    Left atrioventricular plane displacement is related to both systolic and diastolic left ventricular performance in patients with chronic heart failure

    Eur Heart J

    (1999)
  • D. Vinereanu et al.

    Estimation of global left ventricular function from the velocity of longitudinal shortening

    Echocardiography

    (2002)
  • C.J. Carlhall et al.

    Atrioventricular plane displacement correlates closely to circulatory dimensions but not to ejection fraction in normal young subjects

    Clin Physiol

    (2001)
  • Cited by (0)

    View full text